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Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells’ partition

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Petrous bone pneumatization may be related to cerebrospinal fluid (CSF) leak secondary to vestibular schwannoma surgery.

Objective

To assess the association between petrous bone pneumatization and CSF leak in vestibular schwannoma surgery.

Methods

A retrospective study included 222 consecutive vestibular schwannoma patients treated via a retrosigmoid or translabyrinthine approach in a 17-year period in one University Hospital. Association of CSF leak and petrous bone pneumatization, as seen on CT scans, was assessed on ANOVA and Student’s t or Chi-squared test in case of non-parametric distribution.

Results

One hundred and 75 resections were performed on a retrosigmoid approach and 47 on a translabyrinthine approach. Mean age was 53.6 ± 12.9 years. Mean follow-up was 5 years 6 months. Twenty-six patients (11.7%) showed CSF leak and 8 (3.6%) meningitis. Approach (p = 0.800), gender (p = 0.904), age (p = 0.234), body-mass index (p = 0.462), tumor stage (p = 0.681) and history of schwannoma surgery (p = 0.192) did not increase the risk of CSF leak. This risk was unrelated to mastoid pneumatization (p = 0.266). There was a highly significant correlation between internal acousticus meatus (IAM) posterior wall pneumatization and CSF leak after retrosigmoid surgery (p = 0.008). Eustachian tube packing in the translabyrinthine approach did not decrease risk of CSF leak (p = 0.571).

Conclusion

Degree of petrous bone pneumatization was not significantly related to risk of CSF leak, but pneumatization of the posterior IAM wall increased this risk in retrosigmoid surgery. Eustachian tube packing in the translabyrinthine approach is not sufficient to prevent postoperative CSF leak. Both approaches had similar rates of CSF leaks, around 12%.

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Abbreviations

CSF:

Cerebrospinal fluid

CUSA:

Cavitronic ultrasound aspirator

BMI:

Body-mass index

kg/m2 :

Kilograms per square meter

mm:

Millimeter

n :

Number

p :

Probability value

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Authors and Affiliations

  1. Department of Otolaryngology, Head Neck Surgery, University Hospital Gabriel Montpied, Clermont-Ferrand, France

    Olivier Plainfossé, Mathilde Puechmaille, Nicolas Saroul, Laurent Gilain & Thierry Mom

  2. Laboratory of Neurosensory Biophysics, INSERM, Unité Mixte de Recherche (UMR), 1107, Université Clermont Auvergne (UCA), Clermont-Ferrand, France

    Mathilde Puechmaille & Thierry Mom

  3. Department of Otolaryngology, Head Neck Surgery, University Hospital Ponchaillou, Rennes, France

    Benoît Godey

  4. Department of Biostatistics, University Hospital Gabriel Montpied, Clermont-Ferrand, France

    Bruno Pereira

  5. Department of Neurosurgery, University Hospital Gabriel Montpied, Clermont-Ferrand, France

    Toufic Khalil

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  1. Olivier Plainfossé
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Correspondence to Thierry Mom.

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Authors declares that they have no conflict of interest.

Ethical approval

Our Institutional ethical committee approved this retrospective analysis based on a series of patients hospitalized for current clinical care, with full respect of Helsinki Humans Rights, in our University Hospital.

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In our University Hospital, according to European laws and regulations, all patients were informed their charts could be anonymously used for scientific publication, as explained in the standard leaflet they were given at admittance in the unit, and that they were free to refuse so. In these series, there were no refusals.

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Plainfossé, O., Puechmaille, M., Saroul, N. et al. Prevention of cerebrospinal fluid leak after vestibular schwannoma surgery: a case-series focus on mastoid air cells’ partition. Eur Arch Otorhinolaryngol 279, 1777–1785 (2022). https://doi.org/10.1007/s00405-021-06850-1

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